OBJECTIVES

Acute respiratory tract infections (ARTIs) in children are commonly treated with antibiotics. This may contribute to antibiotic-resistance and unnecessary medical costs. To inform appropriate pediatric clinical decision-making regarding antibiotic prescribing, it is important to document prescribing patterns and the outcomes from antibiotic use. Thus, we document antibiotic prescribing patterns for ARTIs in the outpatient pediatric settings and identify factors associated with antibiotic use. We estimate the effects of antibiotic prescribing on the likelihood of revisits within 28 days.

METHODS

Optum Insight Clinformatics claims data, medical and pharmacy claims from 2011-2013, were used to analyze outpatient visits for children (<18 years old) diagnosed with ARTIs. Episode of care was defined around the date of the first ARTI visit (+/- 6 months). Based on whether an antibiotic was prescribed, the rate of treated and untreated was estimated. A multivariable logistic regression was used to identify demographic and clinical factors associated with the patient being treated. A similar model was used to estimate the effect of treatment on the likelihood of initiating a revisit within 28 days.

RESULTS

Antibiotics were prescribed during 47% of the outpatient ARTI visits. Only 6% of all patients initiated a revisit within 28 days. Having received an antibiotic had no impact on the risk of returning for a revisit. Infants (<1 years old) were twice as likely to have a revisit within 28 days compared to patients over 12. Children treated by allied healthcare professionals were 8% more likely to receive an antibiotic prescription but less likely to return for a revisit.

CONCLUSIONS

Receiving an antibiotic prescription does not impact the likelihood of returning within 28 days of the first visit. Allied healthcare professionals fare better than primary care and specialty care physicians in treating children for ARTIs, thus reducing the number of revisits for them.